suPAR Monitoring in ICU Patients at Erasmus Medical Center, The Netherlands

Fri Jun 26 2020

Christian Ramakers, PhD, ESLM, from the Erasmus Medical Center Rotterdam, The Netherlands, highlights the significant role of Erasmus MC among the seven university hospitals in The Netherlands. Specializing in tertiary care, the Erasmus MC in Rotterdam reserves most of its 850 beds for patients requiring complex care, distinguishing itself by working closely with four regional hospitals in the greater Rotterdam area. It stands out as one of the largest hospital care providers in the Netherlands with over 550,000 outpatient clinic visits annually.

Dr. Ramakers emphasizes the critical role of the Department of Clinical Chemistry within the Laboratory Medicine division in supporting medical decisions through lab results. The department not only contributes to patient care but also engages in cutting-edge biomarker research and clinical research projects, including the FORESEEN and CIUM studies. These studies investigate the diagnostic and prognostic value of biomarkers in acute care patients with fever in the Emergency Department and in ventilated ICU patients, respectively, focusing on suPAR among other biomarkers.

Before the SARS-COV-2 outbreak in The Netherlands, the team’s experience with suPAR was mainly retrospective. However, the pandemic’s surge in SARS-COV-2 ICU admissions prompted them to assist ICU doctors more effectively. They rapidly expanded their diagnostic testing panel to include three new biomarkers: KL-6 (Fujirebio), NGAL (Roche Diagnostics), and suPAR (ViroGates), thanks to collaborations with diagnostic partners and ICU colleagues.

“The choice for including suPAR in our testing
panel for our ICU patients came from the wellknown prognostic value of suPAR.”

Dr. Christian Ramakers

The Erasmus MC in Rotterdam.

Fig. 1. The Erasmus MC in Rotterdam.

We chose to include suPAR in our testing panel for ICU patients due to its recognized prognostic value. Traditionally used for ED triage, we believed suPAR could also help predict worsening conditions in SARS-COV-2 patients in the ICU. Our prior experience with suPAR studies allowed us to quickly integrate suPAR analysis into our 24/7 cobas c8000 platform, thanks to our hospital IT department’s support. This integration enabled us to monitor our SARS-COV-2 ICU patients daily with suPAR.

From April 11 to April 19, we collected 775 suPAR measurements from 150 ICU patients, averaging 5 serial results per patient. Although it’s too soon for definitive conclusions, early findings indicate high suPAR levels in our patients. On average, suPAR concentrations were 13 ng/mL (with a standard deviation of 6.6 ng/mL). While some patients had low suPAR levels (in the single digits), others consistently reached our 25 ng/mL linearity cut-off. We observed both stable suPAR levels and progressive increases over the nine-day study period in different patients.

To understand these results better, we’re now correlating the suPAR data with clinical information from the patients’ records. This analysis will include data from both during the hospital stay and long-term outcomes after discharge, highlighting the potential of suPAR as a prognostic tool.

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